Oral Anticoagulation and the Novel Oral Anticoagulants (NOACs):Where Are We at Midterm?

Academic Content

Program Overview

Faculty Presentations

Introduction Deepak L. Bhatt Elaine Hylek

Video Roundtable

Current Activity

Elaine Hylek, MD, MPH, Boston University School of Medicine, Boston, Massachusetts

NOACs in Clinical Care NOACS Prevention Data NOACS: Major Bleeding Meta-Analysis ESC 2012 Guidelines Update Garfield Registry Prophylaxis vs Anticoagulation Clinical Trial: Major Bleeding Benefit and Risk Bleeding Risk Score Consensus Statements CHA2DS2-VASc Bleeding Risk Score Circulation Article Patient Age vs TTR NOACs vs Warfarin NOACS & Renal Dysfunction EHRA NOACs Practical Guide Procedural Management NOACs Bleeding Management Life-threatening Hemorrhage CAT Scans of Cerebral Hemorrhage Intracerebral Hemorrhage: Limited Data Kcentra: FDA approval Safety: Meta-analysis Anticoagulation Antidotes Dose Differences: AFib vs VTE NOACS in Clinical Practice Continuing role for warfarin?

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Patient Age vs Time in Therapeutic Range (TTR)

Figure 15 shows one of the results of the study referenced in the previous Figure.[11] It can be seen that not one of these groups of patients with AFib, arrayed across the x-axis according to deciles of age, consistently spent >60% of time in the warfarin therapeutic INR range, indicated by the red line. Thus is yet another study that serves as something of a wake-up call, because these results remind us that if we are using warfarin, then one of the challenges must be to try to improve the time in the therapeutic range (TTR).

These results suggest that it may be the case that individuals who, despite being adherent to their warfarin regimens, are nonetheless unable to hit this TTR target, should perhaps be targeted more aggressively by their physicians or be switched off of warfarin to a NOAC.

Hylek EM. Am J Med 2014; 00.

References

[11]

Dlott JS, George RA, Huang X, et al. National assessment of warfarin anticoagulation therapy for stroke prevention in atrial fibrillation. Circulation. 2014;129:1407-1414.